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Further advancement of the osteotome after lateral perforation should be strictly avoided. Protection of the nerve by the external rotators is minimal. The best protection is relaxation of the sciatic nerve with full hip extension and some abduction. The rounded edges of the osteotome help to avoid lancing of the nerve. 1 = gluteus medius, 2 = piriformis, 3 = sciatic nerve, 4 = bifid osteotome, and 5 = greater trochanter.
